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August 1985

Microvascular Management of Trigeminal Neuralgia

Arch Neurol. 1985;42(8):802. doi:10.1001/archneur.1985.04210090070020

Seldom have participants in a controversy stated their positions more clearly: Dr Jannetta advocates microsurgical decompression as the treatment of choice for trigeminal neuralgia, whereas Dr Morley thinks the operation should never be done. When reasoning men differ so radically, the differences must arise from different premises. Dr Jannetta takes it for granted that the primary etiology of trigeminal neuralgia is due to pulsatile compression of the junctional area of central and peripheral trigeminal myelin. As Dr Morley points out, such an etiology may explain the 80% of operations that succeed but not the 20% that fail. Moreover, one finds what one looks for. How often can trigeminal compression be found in asymptomatic subjects? What is the nonspecific therapeutic effect of a major operation on pain, a condition whose intensity tends to rise and wane spontaneously?1

A good rationale and good results do not guarantee the correctness of either.